Complexity of antidiabetic medication regimen is associated with increased diabetes-related distress in persons with type 2 diabetes mellitus

Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis

BACKGROUND

Diabetes-related distress (DRD) is a common psychological disorder specifically associated with diabetes, its cross-talk with depression, and glycated hemoglobin (HbA1c) was discussed controversially. Interventions addressing DRD were shown to improve HbA1c. However, the primary concern is to investigate the association of DRD with glycemic control. No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.

AIM

To assess the relationship between DRD, depression, and glycemic control.

METHODS

We systematically searched PubMed MEDLINE, Google Scholar, and Cochrane Library from inception up to May 2024. The keywords diabetes distress, depression, psychopathology, glycemic control, HbA1c, glycated hemoglobin, fasting, and postprandial blood glucose were used. A datasheet was used to extract the author’s name year and country of publication, diabetes distress, depression, and HbA1c among patients with DRD, depression, and control subjects.

RESULTS

Out of the 2046 studies retrieved, 55 full texts were screened and 22 studies were included in the final meta-analysis. Diabetes distress was associated with poor glycemic control, odd ratio = 0.42, 95% confidence interval (CI): 0.17-0.67, and P value < 0.001, and odd ratio = 0.52, 95%CI: 0.38-0.72, and P value < 0.001 respectively. No significant difference was observed between depression and DRD regarding the impact on HbA1c, odd ratio = 0.13, 95%CI: 0.15-0.41, P value = 0.37, I² for heterogeneity = 76%. However, when heterogeneity was eliminated, diabetes distress influenced the HbA1c more compared to depression, odd ratio = 0.29, 95%CI: 0.17-0.41, and P value < 0.001.

CONCLUSION

DRD negatively influenced the HbA1c and glycemic control more than depression. Further studies using more specific measures (ecological momentary assessment) to assess DRD are recommended.

Predictors of medication regimen complexity and its impact on hemoglobin a1c in type 2 diabetes patients: a retrospective analysis in ambulatory care in Makkah City

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact on patient outcomes.

OBJECTIVES

Explore the complexity level of diabetes medications among patients with T2DM and to identify the predictors of medication regimen complexity (MRC) and its correlation with hemoglobin A1C (HbA1c) levels.

DESIGN

Retrospective, cross-sectional study.

SETTING

An ambulatory care setting of a tertiary hospital in Makkah City, Saudi Arabia.

PATIENTS AND METHODS

Patients with T2DM referred to the diabetic clinic were identified and assessed for eligibility. The data were collected from patient electronic medical records between October 2022 and September 2023. The MRC Index was used to evaluate the complexity of the patients' medication regimens.

MAIN OUTCOMES MEASURES

MRC index scores and HbA1c levels.

SAMPLE SIZE

353 records of patients with T2DM.

RESULTS

The analysis revealed that 61.8% (n=218) of patients had high MRC, with the dosing frequency contributing significantly to their MRC (mean=3.9, SD=1.9). Having polypharmacy and longstanding T2DM were predictors of high MRC (odds ratios=4.9 and 2.6, respectively; P≤.01). Additionally, there was an inverse association between the patients' diabetes-specific MRC index scores and their glycemic control (odds ratios=0.2, P<.001).

CONCLUSION

The study findings highlight the importance of considering MRC in managing T2DM. Simplifying medication regimens and optimizing medication management strategies can improve patient outcomes. Further research is needed to explore interventions to reduce MRC and enhance diabetes management in this population.

LIMITATIONS

Retrospective study design measuring the MRC at a diabetes-specific level.

Associations between Diabetes-Specific Medication Regimen Complexity and Cardiometabolic Outcomes among Underserved Non-Hispanic Black Adults Living with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) management and glycemic control in underserved non-Hispanic Black adults presents with multifaceted challenges: balancing the optimal complexity of antihyperglycemic medications prescribed, limited medication access due to socioeconomic status, medication nonadherence, and high prevalence of cardiometabolic comorbidities. This single-center, cross-sectional, retrospective chart analysis evaluated the association of Medication Regimen Complexity (MRC) with cardiometabolic outcomes (glycemic, atherogenic cholesterol, and blood pressure control) among non-Hispanic Black adults with type 2 diabetes. Utilizing 470 independent patient electronic health records, MRC and other covariates were examined to determine their associations with cardiometabolic outcomes. Chi-square tests of independence and multiple logistic regression were performed to identify associations between MRC and cardiometabolic outcomes. Our findings indicate significant negative and positive associations between MRC and glycemic control and atherogenic cholesterol control, respectively. However, there were no associations between MRC and blood pressure control. As diabetes MRC was shown to be associated with poor glycemic control and improved atherogenic cholesterol control, there is a critical need to standardize interdisciplinary diabetes care to include pharmacists and to develop more insurance policy interventions that increase access to newer, efficacious diabetes medications for historically marginalized populations.

Evaluation of a Pharmacist-Managed Diabetes Transitions of Care Medication Management Clinic

PURPOSE

The purpose of this study was to determine the impact of a pharmacist-managed transitions of care (TOC) clinic on outcomes in a posthospitalization population with diabetes.

METHODS

A retrospective single center cohort study utilized electronic health records to identify discharged patients followed by the inpatient endocrinology team. The primary outcome was 30-day readmission rates in the target population. Secondary outcomes include 90-day readmission rates, time to first follow-up, emergency department/urgent care encounters, change in A1C, retention with endocrinology, referrals for diabetes education, and types of interventions. The control group included patients prior to the initiation of the TOC clinic compared to patients seen in the TOC clinic, evenly matched by A1C. Readmission rates and other clinical data were queried up to 4 months after discharge.

RESULTS

Patients in the TOC cohort had similar 30-day readmission rates compared to the non-TOC cohort and were found to have lower A1C values within 120 days of discharge. Overall, patients in the TOC cohort were more likely to have a follow-up appointment and had closer follow-up after discharge.

CONCLUSION

This study highlights that although there was no difference in readmission rates, a pharmacist-managed diabetes TOC clinic may decrease time to follow-up and improve long-term diabetes outcomes.

Association between diabetes distress and sociodemographic and/or socioeconomic factors among adults: A cross-sectional study

Diabetes-related distress (DRD) is a psychological syndrome with worsened prognosis in uncontrolled diabetic patients. The current study aimed to assess the factors contributing to DRD among the Lebanese population using the Diabetes Distress Scale (DDS-17) score and its sub-scores. A cross-sectional analysis was conducted between March and September 2021 enrolling. 125 diabetic from six Lebanese governorates through an online survey. The survey included two parts: the first section gathered sociodemographic data sociodemographic and socioeconomic data and the second one focused on assessing the Diabetes Distress Scale (DDS-17) score. Participants 30 years old and above had higher emotional distress compared to younger patients, (65.2 % versus 45.5 %). Those with a primary educational level showed significantly higher emotional distress than those with a secondary and tertiary level of education (72.5 %, versus 66.7 % and 46.4 %). Participants who were treated with both insulin and non-insulin medications or had a diastolic blood pressure of more than 90 mmHg showed significantly moderate to high distress (63.6 % or 53.8 %). Participants who lived in rural areas showed higher distress (35.6 %). Obese and overweight had significant moderate to high distress (64.1 %, and 48.0 %). The same results were found in non-married (divorced or widowed) and married participants (76.9 % and 51.3 %). The association between medical history with total distress showed that participants with glycemic store HbA1c of more than 6.5 followed by those who had HbA1c between 5.7 and 6.4 showed moderate to high total distress (45.9 % and 40.0 %). It is concluded that the prevalence of DRD is high in Lebanon, more common among rural residents, and among participants high HbA1c, low educational level, unmarried and on complex treatment regimens. Screening for DRD and providing better support can optimize clinical outcomes.

The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores

PURPOSE

This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management.

METHODS

The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R.

RESULTS

The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management.

CONCLUSION

It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Effect of Rifampicin on the Pharmacokinetics of Evogliptin in Healthy Volunteers

Purpose

Evogliptin (DA-1229) is a novel, potent, and selective dipeptidyl peptidase 4 (DPP-4) inhibitor for treating type 2 diabetes mellitus. This study investigates the effect of rifampicin on evogliptin pharmacokinetics.

Patients and Methods

An open-label, crossover, one-sequence study was conducted on 12 healthy subjects. Reference baseline pharmacokinetic samples were collected on day 1 after the subjects were administered a single dose of 5 mg evogliptin. After a washout period, the subjects were administered 600 mg rifampicin once daily for 10 days, from days 8 to 17, for full induction of hepatic enzyme activity. On day 17, single doses of evogliptin (5 mg) were administered along with rifampicin (600 mg). The test pharmacokinetic samples were collected with a sampling schedule identical to that used for the reference.

Results

Maximum concentration (C_max) and area under the plasma drug concentration-time curve (AUC_0-96h) of evogliptin with and without co-administration of rifampicin were compared. Reference and test C_max and AUC_0-96h values of evogliptin were 4.70 ng/mL vs 4.86 ng/mL and 153.97 ng∙h/mL vs 58.83 ng∙h/mL, respectively. All adverse events were mild in intensity and considered unrelated to evogliptin administration.

Conclusion

Rifampicin decreased the AUC_0-96h of evogliptin by 61.8% without significantly affecting C_max. The mechanism underlying the decrease in AUC_0-96h is thought to be the induction of cytochrome P450 (CYP), especially 3A, by rifampicin. The adverse events, none of which were serious, were not significantly altered by the concomitant administration of evogliptin and rifampicin. Nevertheless, it would be prudent that evogliptin dosing should be carefully considered when co-administered with CYP3A inducers.

Diabetes distress in adult patients with type 1 and type 2 diabetes

Background: Diabetes is a chronic and demanding condition, exposing patients to complex physical and mental challenges, and making them particularly vulnerable to distress. Diabetes distress related to disease in diabetic patients is a term encompassing challenges associated with the psychosocial adaptation required of these individuals. Aim of the study: To assess distress in patients with diabetes mellitus. Material and methods: This study was conducted among 107 patients with type 1 and 2 diabetes mellitus reporting for follow-up at a diabetes clinic. The Diabetes Distress Scale (DDS) was used for data collection. Results: Moderate and severe diabetes distress was found in 36.4% and 15% of respondents in the study group, respectively. The total mean score for the DDS was 2.19. The largest percentages of respondents with high levels of distress were observed in patients with a financial situation rated lower than good (30.6%), those having less than secondary education (28.0%), and those under 30 years of age (27.8%). Patients with type 1 diabetes (26.9%), a disease duration > 30 years (30.8%), those using insulin pump therapy (30%) or CGM (Continuous Glucose Monitoring) and FGM (Flash Glucose Monitoring) systems (50%), and those showing ≥ 3 chronic diabetic complications (37.5%) experienced severe distress. Conclusions: Overall, diabetic patients showed a moderate level of distress. The greatest inconveniences caused by the disorder were associated with regimen-related distress and emotional burden. Rural patients with a lower level of education and a lower financial status showed higher levels of distress. Patients experiencing chronic complications from diabetes and those with higher levels of glycated hemoglobin also presented with more severe distress.

Psychometric Evaluation of the Diabetes Distress Scale in Patients with Type 2 Diabetes in Turkey

The objective of the research was to evaluate the validity and reliability of the Diabetes Distress Scale in patients with type 2 diabetes in Turkey. Materials and Methods. Our study was conducted between September 2016 and January 2017 and included 170 patients with type 2 diabetes. The Personal Information Form and Diabetes Distress Scale were used as a data collection tool. Statistical analysis was performed using SPSS 23.0 and SAS package program. Results. According to the results of the research, Cronbach’s alpha reliability for the total scale was 0.91. The model fit indices for the revised confirmatory factor analysis model failed to meet the criteria for acceptability: the GFI was 0.8185, the CFI was 0.9316, the Bentler - Bonett (1980) NFI was 0.9005, and the RMSEA was 0.1067. In our study, exploratory factor analysis provided support for the three-factor model: [I] emotional and regimen-related distress, [II] health professional-related distress, [III] diabetes-related interpersonal distress. Conclusions. When the translation and cultural adaptation process have been considered, the Diabetes Distress Scale is a valid and reliable tool for the Turkish community. It is recommended to be used in the studies and clinical trials.